In an effort to better protect patients and staff, Iredell Health System has expanded visitor restrictions. In keeping with these restrictions, we are providing alternative methods for patients to request medical records. This can be done via fax, mail and email.
This form be completed and returned with the following documentation:
- Valid photo ID
- Representative’s valid photo ID – AND - Valid Healthcare Power of Attorney or Guardianship papers
- Authorization from the patient with a copy of the patient’s valid ID and representative’s valid ID
DECEASED PATIENT REPRESENTATIVE:
- Representative’s valid photo ID
- Death Certificate
- Valid Letter of Appointment - OR – valid Letter of Testamentary – OR – valid Estate Executor documentation – OR – Next of Kin documentation
You can fax, email or mail the request.
Iredell Memorial Hospital
557 Brookdale Drive
Statesville NC, 28677
Attention: Medical Records
Call with any questions: (704) 878-4589